Democratic presidential nominee Harris proposed an expansion of the Medicare program on Tuesday, Oct. 8th, to assist in covering the costs of home health aide care for seniors and disabled people. She also called for adding vision, hearing and dental benefits to Medicare. These are popular provisions among constituents, including Medicare beneficiaries and their families, and would help alleviate financial and other burdens, particularly for those struggling to find affordable in-home care for themselves or aging or disabled relatives.
Nevertheless, if elected president, Harris would likely encounter major hurdles in Congress, both with respect to approval of the expansion of the Medicare program and the main proposed funding route for the plan to include in-home care.
Home health encompasses a wide range of healthcare services that a person can get in their home for an illness, injury, incapacitation or simply inability to fully take care of oneself. Harris’s “Medicare at Home” initiative would pay for health aides to assist seniors and disabled people who “are unable to independently perform activities of daily living like bathing, eating, and going to the bathroom and/or face serious cognitive impairment,” according to a Harris campaign press release. The benefit would be universal in that it would extend to all 67 million of the nation’s seniors and those with disabilities.
The New York Times describes the Medicare expansion plan as one that would help the so-called sandwich generation take care of their aging parents. These adults must take care of their children while at the same time assist their parents to ensure that they can stay at home and not be placed in a nursing or assisted living facility.
Harris said the cost of the new benefit would be offset by a number of measures, including the expansion of the numbers of prescription drugs eligible for Medicare price negotiations, taxes on companies that shift jobs overseas and payments from Medicare recipients on a sliding scale according to household income.
There is a way for people to get the government to pay for long-term, comprehensive home health aide services through Medicaid, the federal-state program for the poor. It covers home care for elderly and disabled Americans who need it. However, to become eligible, people must spend down their savings and often face long waiting periods.
Current Situation In Medicare
Under the existing program rules, Medicare Part A (hospital insurance, such as inpatient stays) and Medicare Part B (medical insurance, such as physician-administered drug infusions) temporarily cover eligible home health services related to a specific care plan, following, say, a surgical procedure, injury or illness. The person being cared for must be “homebound” and require “part-time or intermittent skilled services.” Here, part-time or intermittent means skilled nursing care and home health aide services for up to eight hours a day and a maximum of 28 hours per week.
Medicare doesn’t pay for 24-hour-a-day in-home care, home meal delivery and other services like shopping and cleaning that are unrelated to a specific care plan. Similarly, Medicare does not cover custodial or personal care that helps a person in their daily living activities, including bathing, dressing or using a bathroom, if these aren’t connected to a care plan.
Medicare also does not insure for vision, hearing or dental services, though Medicare beneficiaries can sign up for private Medicare Advantage plans that may offer these as optional benefits in addition to certain home health aide services.
Congressional Hurdles To Medicare Expansion
It’s unclear how much the additional benefits of home health aide, vision, hearing and dental benefits would cost. According to the Associated Press, the Harris campaign pointed to previous proposals for in-home healthcare specifically that had $40 billion price tags per year.
But the expansion of covered in-home services could increase Medicare spending by “tens of billions of dollars” more than the Harris campaign projects, according to a senior economist with the American Enterprise Institute.
And Brookings estimated in 2019 that adding vision, hearing and dental benefits to Medicare would cost approximately $36 billion annually.
The costs associated with proposals that to add benefits for Medicare beneficiaries have proven to be sticking points in Congress in the recent past. For example, President Biden and Democratic lawmakers floated plans to cover vision, hearing and dental benefits, but these were rejected by Congress. Biden also tried to include long-term home health in the Inflation Reduction Act, to no avail. And this was when the Democrats had a majority in both the House and Senate. In addition, efforts more than 14 years ago to address Medicare coverage of long-term care at home never made it into the Affordable Care Act as they were not considered financially feasible, again at a time that Democrats held the presidency and a majority in both chambers in Congress.
Harris says that a bulk of the costs of the home health aide benefits could be offset by the savings the federal government accrues from negotiating lower prices from an increasing number of prescription drugs in the Medicare program. But it’s not clear that these projected savings are as large as the Centers for Medicare and Medicaid Services have stated. And even if the cost offsets would materialize, there’s the question of whether Congress would approve an amendment to the IRA to expand the numbers of prescription drugs eligible to be selected for price negotiation. At present, the Democrats don’t control the House and only have a very slim majority in the Senate. It’s anyone’s guess as to what the make-up of Congress will look like after the November election.
